Robert K. Davies

Symptoms and EEG Findings in the Borderline Syndrome

Symptomatology and electroencephalographic abnormalities were examined in thirty-nine individuals with borderline personality disorder, compared with twenty unipolar depressed patients. Borderline individuals showed a much higher incidence of symptoms commonly seen in complex partial seizures or episodic dyscontrol, and in addition had a much higher incidence of EEG abnormalities, particularly posterior sharp activity. These findings suggest that neurophysiological dysfunction may contribute to the borderline syndrome.

TRH-induced TSH response in unipolar, bipolar, and secondary depressions: Possible utility in clinical assessment and differential diagnosis

Abstract (1) The effect of TRH on TSH and GH release was studied in 32 depressed patients. (2) Patients were diagnosed as having a primary (unipolar or bipolar) or secondary depression and rated with Hamilton ratings at the time of TRH testing. (3) The magnitude of the TRH-induced TSH responses significantly differentiated unipolar and bipolar depressed patients who had similar symptoms, cortisol secretion, and Hamilton ratings. (4) GH responses to TRH were only observed in primary affective, depressed patients. (5) The fact that bipolar depressives had augmented TSH responses while unipolar patients had blunted TSH responses supports the clinical differentiation of these patients and suggests that different neurobiological factors may be involved in these clinically similar states. TRH-induced TSH response may ‘switch’ from augmented to blunted as the patients clinical state changes from depressed to manic. (6) The neural mechanism mediating these TRH test data is difficult to discern on the basis of current studies reported in the literature.

Bromocriptine treatment for cocaine abuse: the dopamine depletion hypothesis.

The authors review the evidence that cocaine exerts its rewarding effects through the acute activation of dopamine (DA) pathways in the brain. Chronic cocaine administration is hypothesized to lead to DA depletion, which results in cocaine craving and cocaine abstinence states. Treatment of these states with bromocriptine, a DA antagonist, appears to have efficacy with acute and maintenance trials, and may represent a new adjunctive treatment for cocaine abuse. DA antagonists appear to exacerbate cocaine craving, which is consistent with the DA depletion hypothesis of chronic cocaine abuse. Theoretical issues relating to drug addiction and endogenous reward centers are discussed.

The thyroid-stimulating hormone response to thyrotropin-releasing hormone in mania and bipolar depression

The release of thyroid-stimulating hormone (TSH) from the pituitary after infusion of 500 microgram of thyrotropin-releasing hormone (TRH) was decreased (p < 0.01) in manic patients and increased (p < 0.01) in bipolar depressed patients compared to a control group of patients with personality disorders. These results suggest that the TRH test may be useful in the diagnosis of psychiatric disorders and in the prediction of response to pharmacotherapy. We discuss the role of central monoaminergic systems in changes in the TSH response to TRH.

Incest: some neuropsychiatric findings.

A review of the medical records of twenty-two patients who were the child or younger member of an incestuous relationship revealed a higher than expected incidence of abnormal neuropsychiatric findings. Seventeen patients had abnormal EEGs; six had clinical seizures; and eight of thirteen patients tested gave evidence of a low IQ or organicity. In addition, indications of impulsivity and depersonalization were frequently found in this group. It could be speculated that these neuropsychiatric handicaps create a vulnerability that enhances inappropriate relationships within a family and makes it more difficult for the person to resist an incestuous relationship.

Thyroid Stimulating Hormone and Growth Hormone Responses to Thyrotropin Releasing Hormone in Anorexia Nervosa

Ten female patients who satisfied objective criteria for the diagnosis of anorexia nervosa were given 500 ug of thyrotropin releasing hormone. Thyroid stimulating hormone and growth hormone responses were measured in duplicate by radioimmunoassay. These patients had a low normal Δ thyroid stimulating hormone but a delayed peak response. In addition, these patients had pathological growth hormone release in response to thyrotropin releasing hormone infusion. Both delayed peak thyroid stimulating hormone and growth hormone response to thyrotropin releasing hormone have been reported for patients with hypothalamic disorders.

Butting Heads: Patients Who Refuse Necessary Procedures:

A patients refusal to undergo a medical procedure may be life threatening and also may lead to feelings which damage the doctor-patient relationship. Efforts to engage in a direct struggle against the refusal often lead to further frustration whereas a more investigative approach often leads not only to an understanding of the causes hut also to ways of solving the dilemma. Cases are presented to illustrate these findings.